Understand the Difference: Acute Onset of Pre-existing Conditions Vs. Pre-existing Conditions Coverage
Purchasing a travel medical insurance policy requires a bit of research by the buyer to ensure that the policy they choose has the benefits and coverage that they are looking for. While almost impossible to find coverage for in the past, a handful of travel medical insurance policies today offer some form of coverage for pre-existing conditions, whether it be for the acute onset of pre-existing conditions or the worsening of pre-existing conditions. While both benefits are in relation to pre-existing conditions, they are not the same and differ in coverage offered.
Understanding the difference between the acute onset of pre-existing conditions and pre-existing condition coverage can definitely be tricky. Exactly what is covered under these two different benefits can also vary from plan to plan. One rule of thumb when choosing a travel medical insurance plan that offers some level of pre-existing condition coverage is to always review the plan’s coverage details and exclusions to understand exactly what the plan offers coverage for as it pertains to pre-existing conditions. However, it is still helpful to have a general understanding of these two benefits and the differences between them.
First, let’s take a look at what a pre-existing condition is defined as when it comes to travel medical insurance.
What Is a Pre-existing Condition?
A pre-existing condition is any ongoing illness, sickness, disease, injury, or other medical, mental, or nervous condition that existed prior to or at the time of applying for a travel medical insurance plan with reasonable medical certainty and if medications or treatments are taken to keep the condition in control, whether known or unknown.
Pre-existing conditions are generally seen as high risk for insurance companies, which is why many travel medical insurance plans don’t offer coverage for pre-existing conditions.
What Is the Acute Onset of Pre-existing Conditions?
Generally, the acute onset of pre-existing conditions refers to a sudden and unexpected recurrence of a previous, pre-existing health condition that may have occurred in the past but was not diagnosed as a chronic condition that the insurer was not currently suffering from or taking medications for at the time of purchasing a travel medical insurance plan.
An attending physician will be able to determine whether your condition is considered acute or chronic based on your medical history and medical examination.
However, it is important to note that the definition of the acute onset of pre-existing conditions coverage will vary from plan to plan and it is highly recommended to review your plan’s policy in full to understand what types of treatments may be covered as they relate to pre-existing conditions.
Why Doesn’t Travel Medical Insurance Typically Cover Pre-existing Conditions?
Travel medical insurance has an important purpose - it provides you with coverage in the event that you have a medical emergency while traveling outside of your home country. However, it is not meant to cover routine medical care or doctor visits which can be taken care of once you return home. It is a short-term insurance plan to provide protection in the event that you need medical care where your domestic insurance wouldn't cover you. Think of a travel medical insurance plan as a safeguard in the event that you become ill or injured while abroad - it isn’t meant to treat chronic or recurring conditions.
This is why travel medical insurance typically doesn’t cover pre-existing condition care, and may only cover the acute onset of pre-existing conditions or the worsening of pre-existing conditions. However, plans that offer a degree of pre-existing condition coverage can offer those who are reluctant to travel due to their conditions more peace of mind that they may be covered in the event that they experience an emergency related to their pre-existing condition while abroad.
What Isn’t Covered by Acute Onset of Pre-existing Conditions Coverage?
Coverage for health conditions that are diagnosed as chronic or congenital are typically excluded from travel medical insurance policies.
Typically, any ongoing medical condition present in the body at the time of purchase for which medications are regularly taken is not considered as acute.
While coverage for acute onset of pre-existing conditions will vary from plan to plan, we recommend checking eligible medical expenses and exclusions on the plan's description of coverage. Here is an example of some treatments that likely will not be covered by this type of coverage:
- Routine checkups
- Preventative care
- Medical consultations
- Prescription medication refill
- Health management classes
What Isn’t Covered by Pre-existing Conditions Coverage?
If you’re choosing a plan that does offer pre-existing conditions coverage, it is very important to understand what this benefit does and does not cover. This will vary from plan to plan, but it is important to note that most plans that offer this benefit may only provide coverage for the worsening of a pre-existing condition. It likely would not cover:
- Second opinions
- Follow-up visits
- Any routine/preventative care related to a pre-existing condition
- Prescription refills
- Elective treatments
How to Choose the Right Travel Medical Insurance Plan
Choosing a travel medical insurance plan can be overwhelming considering the amount of options you have and the benefits to consider. However, if you have a pre-existing condition or are purchasing a plan for a family member who has a pre-existing condition, you may want to consider a plan that offers pre-existing conditions coverage.
While it may not cover the routine care of their pre-existing condition, it may cover a medical emergency event or worsening of their pre-existing condition while abroad. It is also important not to assume that your travel medical insurance plan covers certain pre-existing conditions. It's always best to review a plan's detail of coverage in full to completely understand their pre-existing condition coverage.